What are liver enzymes or aminotransferases?
An initial step in detecting liver damage is a simple blood test to determine the presence of certain liver enzymes in the blood. Under normal circumstances, these enzymes reside within the cells of the liver. But when the liver is injured, these enzymes are spilled into the blood stream, raising the enzyme levels in the blood and signaling liver damage. Among the most sensitive and widely used of these liver enzymes are the aminotransferases. They include aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT).

Another name for aminotransferase is transaminase. The enzyme aspartate aminotransferase (AST) is also known as serum glutamic oxaloacetic transaminase (SGOT); and alanine aminotransferase (ALT) is also known as serum glutamic pyruvic transaminase (SGPT). To put matters briefly, AST = SGOT and ALT = SGPT.

What are normal levels of AST and ALT?
The normal range of values for AST (SGOT) is from 5 to 40 units per liter of serum (the liquid part of the blood). The normal range of values for ALT (SGPT) is from 7 to 56 units per liter of serum.

What do elevated AST and ALT mean?
AST (SGOT) and ALT (SGPT) are sensitive indicators of liver damage from different types of disease. In rare cases, higher-than-normal levels of these liver enzymes may have causes other than liver problems. The interpretation of elevated AST and ALT levels depends upon the whole clinical picture. The precise levels of these enzymes do not correlate well with the extent of liver damage or the prognosis. Thus, the exact levels of AST (SGOT) and ALT (SGPT) cannot be used to determine the degree of liver disease or predict the future. For example, patients with acute viral hepatitis may develop very high AST and ALT levels (sometimes in the thousands of units/liter range). But most patients with acute viral hepatitis A recover fully without residual liver disease.

What liver diseases cause high liver enzyme levels?
The highest levels of AST and ALT are found with disorders that cause the death of numerous liver cells (extensive hepatic necrosis). This occurs in such conditions as acute viral hepatitis A or B, pronounced liver damage inflicted by toxins as from an overdose of acetaminophen (Tylenol), and prolonged collapse of the circulatory system when the liver is deprived of fresh blood bringing oxygen and nutrients. AST and ALT serum levels in these situations can range anywhere from ten times the upper limits of normal to thousands of units/liter.

The most common cause of mild to moderate elevations of these liver enzymes is fatty liver. In the United States, the most frequent cause of fatty liver is alcohol abuse. Other causes of fatty liver include diabetes mellitus and obesity. Chronic hepatitis C is also becoming an important cause of mild to moderate liver enzyme elevations.

What are the treatment options for high liver enzymes?
Evaluation of healthy patients with abnormal liver enzymes needs to be individualized. If alcohol or prescription drugs are responsible for the abnormal liver enzyme levels, stopping alcohol or the medication (under a doctor's supervision) should help. If obesity is suspected as the cause of fatty liver, weight reduction of 5% to 10% should also bring the liver enzyme levels to normal or near normal levels. If abnormal liver enzymes persist despite abstinence from alcohol, weight reduction and stopping certain suspected drugs, blood tests can be performed to help diagnose treatable liver diseases. The blood can be tested for the presence of hepatitis B and C virus and their related antibodies.

About Milk Thistle

Milk Thistle, also known as Silybum marianum or Holy Thistle, has been used for over 2,000 years to support healthy liver and gall bladder function. The plant gets its name from the milky white fluid that is expressed from the leaves when they are crushed. The active ingredient in Milk Thistle, the one believed to help support liver health, is known as Silymarin. Silymarin has antioxidant properties and may help protect liver cells from damage by environmental toxins and support overall liver health. In fact, Milk Thistle is the world's most researched and #1-selling herb for liver health.

Health Benefits of Milk Thistle

Milk Thistle has traditionally been used for its antioxidant and hepato-protective properties to support healthy liver function. Milk Thistle's benefits include the following:

It is the #1-selling herb for maintaining the functional efficacy of the liver*

Has antioxidant properties and supports overall liver health*

Helps protect the liver from toxins in the air, food, and water*

May offer protection to the liver from side effects of certain drugs (e.g. acetaminophen (Tylenol) and statins), which can cause liver damage in high doses or when used over extended periods of time*

May protect the liver from potentially dangerous free radical damage produced as a result of the body’s basic metabolic functions*

Please consult your healthcare provider before taking this supplement if you are pregnant, breastfeeding, and/or currently taking any OTC or prescription medications for a health condition. Store in a cool, dry place. Keep out of the reach of children.

Frequently Asked Questions

How do I know if I need to take Milk Thistle?
The liver is one of the largest organs in our body, second only to the skin, and responsible for over 500 vital functions including, but not limited to, breaking down food, insulin, hormones and medications, synthesizing proteins, metabolizing carbohydrates and lipids (including regulating cholesterol levels), red blood cell production during the first trimester of pregnancy, and emulsifying fats using bile. It follows that, over time, the liver may become tired and sluggish, and liver fatigue can impact overall well being. Taking Milk Thistle as part of a healthy daily regimen can help maintain optimal liver health and protect the liver from free radical cell damage and damages caused by environmental toxins.

What is the active ingredient in Milk Thistle?
The active ingredient in the Milk Thistle plant, the one that is thought to have protective benefits for the liver, is known as Silymarin. Silymarin is actually a group of flavonoids, including Silibinin, Silidianin, and Silicristin, which are thought to help protect the liver from the damaging effects of environmental toxins.

Is Milk Thistle GOLD™ free of allergens and GMOs?
Milk Thistle GOLD™ is verified free of corn, egg, gluten, milk, peanut, shellfish and soy allergens by an independent, third-party lab. It is also verified free of GMOs by the Non-GMO Project™.

Is Milk Thistle GOLD™ suitable for Vegans / Vegetarians?
Milk Thistle GOLD™ does not contain any animal-derived ingredients and is, therefore, suitable for both vegans and vegetarians.

How long does it take to notice benefits?
Unlike OTC and prescription drugs that provide instant, temporary, symptomatic relief, herbal supplements provide progressive, long-term benefits by strengthening and supporting the body's natural defenses. Most herbal supplements, including Milk Thistle GOLD™, need to be taken for at least 8 to 12 weeks before the benefits of taking the supplement can be experienced. Please be advised that nutritional supplements work best when they are taken as part of a health maintenance program that includes a sensible diet rich in whole grains, fruits, and vegetables, a moderate exercise program, and the necessary lifestyle changes to support wellness.

Does Milk Thistle GOLD™ contain anything other than the active ingredient?

In addition to the active ingredient, each vegetarian capsule of the Milk Thistle GOLD™ product contains some gluten-free rice concentrate. Because natural extracts can vary from batch to batch in terms of consistency, moisture (or stickiness) and particle size, it is sometimes necessary to add rice flour during the manufacturing process to help ensure product integrity without compromising product safety or effectiveness.

Does Milk Thistle GOLD™ have any side effects or interactions?
Milk Thistle GOLD™ features a plant extract and is generally well tolerated. It has been prescribed for use in most European countries to support liver health for almost 30 years. In rare cases, a mild laxative action has occasionally been observed, which can be minimized by taking Milk Thistle GOLD™ during or right after a meal.

Pregnant and lactating women should not take Milk Thistle. Little is known about the interactions between Milk Thistle and OTC and prescription drugs, so individuals currently taking or planning to take any OTC or prescription medication should take Milk Thistle only under the guidance of a healthcare professional.

Is Milk Thistle GOLD™ safe for long-term use?
Milk Thistle GOLD™ is generally regarded as safe at the recommended dosages and there have been no reports of toxicity when taken over a long period of time (up to 6 years).

How to check for high liver enzyme levels:

How are healthy people evaluated for mild to moderate rises in aminotransferase levels?
Evaluation of healthy patients with abnormal liver enzymes needs to be individualized. A doctor may ask for blood test data from old records for comparison. If no old records are available, the doctor may repeat blood tests in weeks to months to see whether these abnormalities persist. The doctor will search for risk factors for hepatitis B and C including sexual exposures, history of blood transfusions, injectable drug use, and occupational exposure to blood products. A family history of liver disease may raise the possibility of inherited diseases such as hemachromatosis, Wilson's disease, or alpha-1-antitrypsin deficiency.

The pattern of liver enzyme abnormalities can provide useful clues to the cause of the liver disease. For example, the majority of patients with alcoholic liver disease have enzyme levels that are not as high as the levels reached with acute viral hepatitis and the AST tends to be above the ALT. Thus, in alcoholic liver disease, AST is usually under 300 units/liter while the ALT is usually under 100 units/ liter.

If alcohol or medication is responsible for the abnormal liver enzyme levels, stopping alcohol or the medication (under a doctor's supervision only) should bring the enzyme levels to normal or near normal levels in weeks to months. If obesity is suspected as the cause of fatty liver, weight reduction of 5% to 10% should also bring the liver enzyme levels to normal or near normal levels.

If abnormal liver enzymes persist despite abstinence from alcohol, weight reduction and stopping certain suspected drugs, blood tests can be performed to help diagnose treatable liver diseases. The blood can be tested for the presence of hepatitis B and C virus and their related antibodies. Blood levels of iron, iron saturation, and ferritin (another measure of the amount of iron stored in the body) are usually elevated in patients with hemachromatosis. Blood levels of a substance called ceruloplasmin are usually decreased inpatients with Wilson's disease. Blood levels of certain antibodies (anti-nuclear antibody or ANA, anti-smooth muscle antibody, and anti-liver and kidney microsome antibody) are elevated in patients with autoimmune hepatitis.

Ultrasound and CAT scan of the abdomen are sometimes used to exclude tumors in the liver or other conditions such as gallstones or tumors obstructing the ducts that drain the liver.

Liver biopsy is a procedure where a needle is inserted through the skin over the right upper abdomen to obtain a thin strand of liver tissue to be examined under a microscope. The procedure is oftentimes performed after ultrasound study has located the liver. Not everybody with abnormal liver enzymes needs a liver biopsy. The doctor will usually recommend this procedure if 1) the information obtained from the liver biopsy will likely be helpful in planning treatment, 2) the doctor needs to know the extent and severity of liver inflammation/damage, or 3) to evaluate the effectiveness of treatment.

Liver biopsy is most useful in confirming a diagnosis of a potentially treatable condition. These potentially treatable liver diseases include chronic hepatitis B and C, hemachromatosis, Wilson's disease, autoimmune hepatitis, and alpha-1-antitrypsin deficiency.

How about monitoring liver enzyme levels?
What is usually most helpful is serial testing of AST (SGOT) and ALT (SGPT) over time to determine whether the levels are going up, staying stable, or going down. For example, patients undergoing treatment for chronic hepatitis C should be monitored with serial liver enzyme tests. Those responding to treatment will experience lowering of liver enzyme levels to normal or near normal levels. Those who develop relapse of hepatitis C after completion of treatment will usually develop abnormal liver enzyme levels again.

Know your Liver:

Liver is the biggest and the most complex organ in the body with more than 500 functions

The liver is an "incredible chemical factory," producing many important chemical compounds needed to survive, such as bile, albumin, blood clotting factors, cholesterol, Vitamin E.

Converts amino acids (proteins) and lipids into glucose, a complex process catalyzed by a series of enzymes

Plays a major role in maintaining normal blood sugar levels, an important source of energy for the brain, heart and muscles.

Performs numerous other functions such as regulating lipids or metabolizing prescribed and over the counter drugs, alcohol, and many other ingested chemicals such as caffeine, etc.

Helps digest the food we eat and assists in ridding our body of many toxins.

Eliminates various harmful chemicals from the body. Treats about 1,300 ml of blood per minute, thereby acting as the body's "garbage disposal."

Liver dysfunctions may take many forms

4,000,000 people have Hepatitis C in the United States, causing 10,000 deaths every year.

Cirrhosis of the liver is the eighth leading cause of death in the United States - kills 25,000 people per year.

Commonly prescribed cholesterol-lowering medications such as statins (e.g. Lipitor), among many other chemical drugs, are known to be toxic to the liver.

Widely taken OTC medications are not as safe as they seem. For example, Acetaminophen (e.g. Tylenol) can be toxic to the liver and its toxicity can be accentuated by alcohol.

The American Journal of Emergency Medicine, notes that in one year, hospitals treated over 26,765 patients for alcohol toxicity and another 16,635 for Acetaminophen (Tylenol) toxicity.

Fatigue, aches, and pain in joints and muscles, frequent headaches, stress and appetite fluctuations may be signs of an over-worked liver.

Information on this website is provided for informational purposes and is not meant to substitute for the advice provided by your own physician or other medical professional. Information and statements contained herein have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.